In June 2006, the Food and Drug Administration FDA approved the HPV vaccine GARDASIL(r) for use by females between the ages of 9 and 26 and the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recommended that the vaccine be routinely given to girls when they are 11-12 years old. The ACIP recommendation also allows for vaccination of girls beginning at age nine as well as catch-up vaccination of girls and women 13-26 years of age. The vaccine protects against HPV types 16 and 18, which cause approximately 70 percent of cervical cancers and against HPV types 6 and 11, which cause approximately 90 percent of genital warts. However, despite remarkable advances in the prevention of other diseases through vaccination, current rates of immunization coverage are suboptimal among children and adults in the U.S. Thus, to achieve the overall goal of reducing HPV infection, cervical cancer and other HPV-related diseases, it is imperative that physicians recommend and advocate for HPV vaccination. We propose to conduct two serial population based cross sectional surveys of a nationally representative sample of physicians representing pediatric, obstetrics/ gynecology, and family medicine disciplines. Over a four year period, we will complete surveys with 1000 physicians at two time points (total of 2000 physicians) in the diffusion of HPV vaccination: 3 and 5 years post HPV vaccine licensure. The main aims of the study are to: (1) determine the prevalence of physician recommendation to vaccinate for female patients in various age groups within the past 12 months; (2) assess factors independently associated with physician recommendation to vaccinate at the physician, practice, and state policy levels; and (3) assess changes in physician recommendation to vaccinate for females in various age groups over time, and the factors that underlie these changes. This study will identify physician factors, but also practice and policy level factors that may influence physician recommendation and vaccine delivery, allowing for the development of comprehensive interventions to encourage and support physician recommendation of HPV vaccination. By addressing issues related to physician recommendation this new vaccine, the proposed study will serve as an important and necessary step toward realizing the social and economic public health benefits of HPV vaccination. PUBLIC HEALTH RELEVANCE: In June 2006, the Food and Drug Administration FDA approved the first ever vaccine against certain types of Human Papilloma Virus (HPV). The vaccine protects against specific types of HPV which cause approximately 70% of cervical cancers and approximately 90% of genital warts. The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) recommended the vaccine be routinely given to girls aged 11-12 years. The ACIP recommendation also allows for vaccination of girls beginning at age nine as well as catch-up vaccination of females 13-26 years of age. However, despite remarkable advances in the prevention of other diseases through vaccination, current rates of immunization coverage are lower than expected among children and adults in the U.S. To achieve the overall goal of reducing HPV infection, cervical cancer and other HPV-related diseases, it is imperative that physicians recommend and promote the use of HPV vaccination. Because this vaccine is new and little is known about how physicians are responding to and practicing use of the vaccine. We propose to conduct a series of surveys of a national sample of pediatricians, obstetrician/gynecologists, and family medicine physicians at 3 and 5 years post-HPV vaccine licensure. Over a four year period, we will complete surveys with 1000 MDs at these two time points (total of 2000 physicians). The main goal of the study is to determine the extent to which physicians in these specialties recommend HPV vaccine to their female patients. In addition, we will assess factors at the level of the physician (e.g., specialty, age, knowledge), practice (e.g., size of group, location of practice), and state policy (e.g., school age entry requirements related to HPV vaccination) that may impact physician recommendation and use of the vaccine. By conducting this survey at 2 time points, we will also better understand whether changes in any of these factors result in changes in physician recommendation and use of HPV vaccination. The data obtained from this study will allow for the development of comprehensive interventions to encourage and support physician recommendation of HPV vaccination. By addressing issues related to physician recommendation of this new vaccine, the proposed study will serve as an important and necessary step toward realizing the social and economic public health benefits of HPV vaccination and contribute to reducing the burden of disease caused by HPV for generations of women. 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